Payment Accuracy Data Mining Specialist

Overview

Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our healthcare recovery team as a Payment Accuracy Specialist.

This role is part of Cotiviti's Data Mining team, and configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types. The team is also responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, identifies and inputs recovery claims, voids, or other over-underpayment types. Documents relevant facts, information and conclusions drawn to support the work performed and validate the claim. Communicates audit recommendations to the supervisory auditor for evaluation, verification, and continuous learning. Displays professional skepticism that enhances the work performed to achieve success in the position.

Responsibilities

• This individual will work under direct supervision and will be monitored for efficiency in production and quality review of assigned work.
• Has the ability to build and maintain a basic understanding of Centers for Medicare and Medicaid Services (CMS) and National Association of Insurance Commissioners (NAIC) guidelines to establish the correct order of liability.
• Utilizes Cotiviti audit tools and specific client systems to complete auditing, review simple - medium proprietary reports, has a proficient understanding of Microsoft Excel and client applications.
• Audits standard reports and paid claims to identify over and underpayments of claims. The scope may include Data Mining, Claim Adjudication, Contract Compliance, Provider Billing & Duplicate Payment Reviews, Policy & Reimbursement Analysis, and Quality Assurance across various clients. Assigned to simple - medium reports.
• Meets or exceeds standards for productivity, in addition to regular and predictable attendance, maintains production goals and standards set by the audit for the auditing concept. Audits against the expected level of quality and quantity for assigned work.
• Meets or exceeds standards for quality set by the audit for the auditing concept, for valid claim identification and documentation.
• Prepares and evaluates responses to client disputes both internally and externally within the Business Unit as needed.
• Reviews client transactions by building personal proficiency around provider contracts and vendor agreements. Makes recommendations on medical policy applications, state and federal statutes, and other reimbursement methodologies as it applies to the audit concept.
• Has a basic understanding of the healthcare industry, as well as proven track record of delivering results.
• Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
• Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements. Demonstrates the skills, knowledge, and ability to ensure that our environment is safe, complying with industry standards.

Qualifications

Understands and embodies Cotiviti Core Values, Strategic Pillars, and Operations Disciplines to achieve successful performance in completing assigned responsibilities and interactions with the Organization both internally and externally.

Mental Requirements :

Physical Requirements and Working Conditions :

Base compensation ranges from $21.00 to $24.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for discretionary bonus consideration.

Nonexempt employees are eligible to receive overtime pay for hours worked in excess of 40 hours in a given week, or as otherwise required by applicable state law.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our

Date of posting : 8 / 21 / 2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 9 / 21 / 2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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Entrylevel

Cotiviti is an equal employment opportunity employer. Cotiviti recruits, hires and promotes individuals based on their qualifications for a specific job. Selection of employees is made without regard to race, color, creed, sex, age, religion, pregnancy or pregnancy-related conditions, national origin, sexual orientation, gender identity, marital status, genetic carrier status, military service, veteran status, uniformed service member status, disability, or any other category of class protected by federal, state or local laws. All employment decisions and personnel actions, such as hiring, promotion, compensation, benefits, and termination, are and will continue to be administered in accordance with, and to further the principle of, equal employment opportunity.

Pay Transparency Nondiscrimination Provision

Cotiviti will not discharge or in any manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-I.35(c)